1 alberta’s influenza immunization program tarrant workshop elaine sartison ahw march 24 2007
TRANSCRIPT
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Alberta’s Influenza Immunization Program
TARRANT WorkshopElaine Sartison
AHWMarch 24 2007
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Partners
AHW participates in a bulk purchase program with all jurisdictions in Canada facilitated by PHAC
AHW then distributes this vaccine to Regional Health Authorities (RHAs)
Physicians are important partners in the delivery of publicly funded influenza vaccine in Alberta
Physicians can order influenza vaccine from RHAs for patients eligible for publicly funded vaccine
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Partners
The proportion of publicly funded vaccine delivered by physicians varies between RHAs in Alberta. Approx. 50% delivered by PH staff Approx 50% delivered by physicians who see
patients with a chronic illness
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Purchased 800,000 doses (2006/07 season) Vaccine is distributed to all public health centers in
Alberta to manage RHAs accountable for all doses distributed within
their region Follow AHW eligibility criteria and adverse event
surveillance guidelines
Process
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Influenza Vaccine
Goal: To reduce morbidity, mortality and the impact of illness associated with influenza
NACI Statement The two main areas of focus:
Those at high risk for influenza-related complications
Those capable of transmitting influenza to individuals at high risk for complications
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Influenza Predominant StrainPredominant Sub-Type
2001
2002
2002
2003
2003
2004
2004
2005
2005
200620062007
B/Hong Kong/330/2001
B/Malaysia/2506/2004)
A/New Caledonia/20/99(H1N1)
A/California/7/2004 (H3N2)
A/Wisconsin/67/2005)
A/Fujian/411/2002
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2006-2007 Vaccine Strains
A/New Caledonia/20/99 (H1N1)
A/Wisconsin/67/2005 (H3N2)
B/Malaysia/2506/2004
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Target Groups 1. People at high risk for influenza related
complications:Persons with chronic pulmonary and cardiac disorders LTC residentsPersons 65 years of age and olderThose with specific chronic conditions Adults and children with any condition that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk of aspiration. HIV positive personsPregnant women who are at high risk for influenza-related complications as listed abovePersons 6 months to 18 years of age on long-term ASA therapyHealthy children age 6 to 23 monthsThe chronically disadvantaged People in direct contact with avian influenza-infected poultry during culling operations
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Target Groups, continued
2. People capable of transmitting influenza to those at high risk:
Health care workers (HCW) and other personnel who have significant contact with those at high risk
***HCW and their employers have a DUTY to actively promote, implement and comply with influenza immunization recommendations***
ALL household contacts of persons at high risk for influenza-related complications
Pregnant women expected to deliver during influenza season
Those providing regular childcare to children age zero to 23 months, whether in or out of the home
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Provincial Targets
75% of all individuals 65 years and older 70% of all persons under 65 years of age with
chronic health conditions 90% of all residents of long-term care facilities 60% HCW moving towards 90% 60% of healthy children 6-23 months of age
moving towards 95%
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Achievement 2000 to 2006
Doses
Administered
65+Immunized
Rate%
#LTC
ResidentsRate
%
20002001
381,475 201,412 67% 14,716 93%
2001
2002397,797 205,297 67% 13,692 92%
2002
2003390,144 206,962 66% 13,863 90%
2003
2004492,412 220,330 68% 13,508 91%
2004
2005610,733 229,218 69% 13,420 91%
2005
2006662,409 232,566 68% 13,199 92%
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0
10
20
30
40
50
60
70
80
90
100
2000-2001 2001-2002 2002-2003 2003-2004 2004-2005 2005-2006
65 years and over immunizedLTC Residents Immunized6-23 months old immunized
2000-2006 Immunization Ratesby Select Groups
Percentage
91%
69%
91%
68%
90%
667%
92%
67%
93%
67%
40% 68%
60%
92
%
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2006-2007 Vaccines
FluviralTM
VaxigripTM
VaxigripTM (T-free)
ThreeThree vaccines were be publicly funded in vaccines were be publicly funded in AlbertaAlberta
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FluviralTM
Split trivalent vaccine
Manufacturer GSK (formerly ID Biomedical) 10 dose vial No latex Thimerosal content 50 µg/0.5 mL Discard opened vial after 28 days For general use in at risk persons, 9 years and
older
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VaxigripTM
Split trivalent vaccine Manufacturer Sanofi Pasteur Multi-dose vial No latex Reduced thimerosal: 2µg/0.5 mL Discard opened vial after seven days For use with children age: < 9 years of age, pregnant
women (if requested), and those with a severe sensitivity to thimerosal
3 ml syringes most often used in dosages 0.5 ml 1 ml syringes used in dosages 0.25 ml
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VaxigripTM (T-free) Split trivalent vaccine Manufacturer Sanofi Pasteur No thimerosal used at any point in production Pre-loaded 5/8 inch syringe 6-23 month olds pending muscle size in the 6-11
month old children 0.25 mL No latex in the syringe
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Reporting Adverse Reactions
Surveillance of ALL influenza vaccine-associated events with no enhanced surveillance of ORS
Use Report of Adverse Reaction to Immunizing Agents form (Jan. 2004)
Physicians would either complete this form or direct their patients to public health for follow-up
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NACI Statement on ORS
It is safe to re-immunize individuals who have experienced Mild or moderate ORS symptoms Severe ORS symptoms without lower respiratory
symptoms Consultation with the local MOH for those
who experienced severe ORS symptoms with lower respiratory symptoms within 24 hours of receiving influenza vaccine.
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Communication
Letter/guidelines to MOH/CD contacts
Physicians through AMA newsletter
Press release by AHW this fall pending key messages from PHAC
Health Link Alberta
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Hot Issues
Why thimerosal-reduced and thimerosal-free used even though not considered a risk? Theoretical risk – follow the precautionary
principle to reduce exposure Maintain public confidence in vaccines What other jurisdictions in Canada
are providing
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Hot Issues, continued
Vaccine supply for the private market Solvay Pharma Inc Belgian based pharmaceutical Provided to some provinces last flu season Influvac
Some product confusion – licensed for adults only
Vaccine supply for provincially funded programs late two consecutive years Delayed influenza program to November 1st
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Future Considerations
• provision of information for physicians to give to patients
• timely delivery of vaccine to physician’s offices
• availability of vaccine for the whole influenza season pending vaccine supply issues
• provincial electronic health record so physicians’ can access immunization information (influenza may not be included for all regions)
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Possible Best Practices:
• consider the physician’s office as an important access site
• provide annual information on the vaccine and vaccination program for physicians
• provide multiple/additional public health clinic sites
• other providers of influenza vaccine should be connected to public health